Tuesday, June 10, 2008

WHAT CHOICE DO I HAVE?

I remember my first meeting with the obstetrician in his rooms in Melbourne, when I was pregnant for the first time.I came dressed nicely, and my husband Noel accompanied me.Noel was asked politely to wait – he would be invited in to meet the doctor after he had performed his examination.I was instructed to take my clothes off, to don the white examination gown, and lie on the firm narrow couch.My abdomen and breasts were palpated, and my vagina pried by a man in a grey pin-stripe suit, a crisp white shirt and a bow tie, which was the standard attire for men of such professions at the time.I was then asked to dress, and the doctor would come back and speak to me.

Innocently I informed the doctor that I was a midwife, and that I wanted a natural birth.He gave a reply that I understood as ‘we shall see’.At some pre-determined moment Noel was invited into the interview, sat on a chair next to me, and he asked some question.

“Mrs Johnston and I have already discussed that” was the reply, in a dismissive tone that indicated that the deal had already been done, so he need not exercise his mind on it.

My ‘choice’ to plan to have a natural birth was, I thought, simple.Young people today would call it a ‘no brainer’.Many of those same young women today go into maternity care with the same degree of innocent trust that I had.And many experience the authoritarian conquering power of the obstetrician who looks over her glasses and says “We shall see!”

If we stopped to assess the quality of the offered service by asking questions such as “How many first time mothers in your practice last year experienced uncomplicated, unmedicated, spontaneous birth?”, we may discover that this person is not skilled at protecting normal birth.And why should they be?They are surgeons whose education and registration prepare them as specialists, most with very little knowledge of working in harmony with and supporting natural female rhythms.

It’s as though we have blinkers on our eyes.We wouldn’t go into buying a house or a car or even a pair of shoes with the same lack of critical thinking that we seem to easily adopt when it comes to having a baby, which is surely the most significant investment of time, energy, and every other resource at our disposal that we will ever experience.

This past Sunday evening there was a segment called ‘Birth Choice’ on Chanel 9’s 60 Minutes.I watched it and became increasingly more distressed as time went by.The show presented two extremes, DIY homebirth, without a midwife, compared with the ‘too posh to push’ caesarean birth on demand.It was sensationalist and misleading not a rational or responsible presentation of the choices a woman faces in birth.Presenting the opinion of an obstetrician on homebirth is similar to asking the manager of a nursing home about parenting issues.Uninformed!

I want to be fair in my criticisms – the filming of the homebirth was done in a respectful and delicate way. It was a spontaneous, uncomplicated, unmedicated birth in water, and the baby was in excellent condition, which is what I would have expected.Yet I felt sympathy for the un-midwifed mother, who was under the prying eye of the video camera, and had noone who had the knowledge or skill to say "You are well; your baby is well. Take this beautiful little girl into your arms and love her." The mother was concerned about her blood loss after the birth, and went to the hospital. I hope she was midwifed well there.

I cannot understand the woman who chooses major surgery - surely she has been sold a lie? The notion of keeping things tight "down there". Oh dear!

There are some mothers and babies who have needed and accepted surgical births, and who are thankful for the 'good' outcomes. I am also thankful for good outcomes. This is also a 'no brainer'. But I have also seen the women who have suffered surgical complications - infections, retained swabs, drug errors, haemorrhage, impaired clotting, pain, and a great deal of psychological trauma of separation and disturbed bonding. These are not good outcomes.

It is with this knowledge that I will continue to work to protect and promote healthy natural processes, and support normal birthing when ever I can. I believe we have only one real choice - that is, to either work in harmony with our healthy natural processes in pregnancy, birth, and parenting, or to ignore them. Medical options at present in developed countries like Australia offer surgical options which come at a cost. It is important, I believe, that the cost as well as the potential benefit of avoidance of natural birthing be understood before choices are made.

1 comment:

Joy, I too watched the 60 minutes program on Sunday and was revolted by so much in the story. So much so that I joined the chat room afterwards to speak to the Obstetrician featured in the story. A few things to note: The obstetrician Michael van der Griend continued to state online that there was very little difference in the recovery and bonding process that happens with a natural birth and a caesarian birth. In response I asked him how much time he spent with women after birth assisting them with establishing breast feeding. This question was not answered. Another participant asked if his own daughter was going to give birth, which option would he prefer - natural or caesarian. He replied that either option would be fine. I pointed out to him that surely a surgeon would stand to benefit from marketing and promoting a surgical option to women and that it makes good business sense. He failed to reply to this comment also.Thanks Joy, for giving me choice and strength to explore home birth to bring my baby into the world in a few weeks time. I am so grateful that there are people like you today.Monica

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Retired from clinical practice

I have retired. Joy JohnstonMobile: 0411190448

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About me

I have been a midwife since 1973, and have practised independently, attending births in homes since 1993.

My four children, born after I qualified as a midwife, taught me that the medical model of care was not suitable for a well woman. The first three, born in a hospital in Lansing, Michigan, taught me that I could push boundaries. The fourth, born at a birth centre in Melbourne Australia, opened up new possibilities, and new philosophies. The babies themselves taught me about birthing and breastfeeding. My first grand-daughter, born into my hands, has brought to my life and loving a wonderful new dimension. The birth of each subsequent grand-child has been a precious time for me.

I learn more from every woman who takes me into her life for the birth of her child. I learn more from each wonderful baby as she or he enters our world.

It is not easy to practise as an independent midwife in Melbourne. Women do not, as a rule, question the care that is available through our health system. Women giving birth are usually submissive to the dominant medical system. Options are not well understood, and not widely available.

Women who choose midwife care are discriminated against financially. Whereas free hospitalisation and subsidised visits to the doctor are available to all, care by a known midwife is usually expensive, except in isolated public hospital programs.

In recent years I have been less able to ignore ageing, and I have realised that I need to write my stories, and share my professional knowledge so that it is not lost when I am no longer able to practise.

Thankyou for visiting my blog. I hope you will find it informative and useful. Please leave a comment or contact me joy@aitex.com.au